Suicide rates have increased in nearly every US state over the past two decades, with half of states experiencing a more than 30% increase in that time. It is therefore a major public health issue.

Mental health disorders such as depression can lead to suicidal thoughts. As many as one in five teenagers suffers from clinical depression and suicide is the third leading cause of death for Americans between the ages of ten and twenty-four.

Crisis Text Line recognises that many people in crisis, whether suffering from depression, bullying, suicidal thoughts, abuse or other issues, feel unable to speak out loud about what is happening to them or how they are feeling. It is the first and only national 24-hour crisis-intervention hotline to conduct its conversations exclusively over text message.

For young people in particular, who make up the majority of Crisis Text Line’s users, discussing or disclosing via text message can seem a lot less daunting than picking up the phone and having to speak out-loud to someone.

Anyone who contacts Crisis Text Line will receive a response from a real person – a counsellor on duty behind a computer screen. An average exchange takes place over a little more than an hour, longer if there is the risk of suicide.

Counsellors are trained to put texters at ease and not to jump too quickly with solutions and instructions. They ask open-ended questions and avoid making assumptions or using language that a person might not know. Techniques that are encouraged include validation of feelings (“What a tough situation”); “tentafiers” (“Do you mind if I ask you . . . ”); and empathetic responses (“It sounds like you’re feeling anxious because of all these rumours”). They allow the texters to speak freely without trying to provide all the answers or probing with too many questions.

People feel compelled to contact Crisis Text Line for a variety of reasons, but however minor the prompt to reach out, having a stranger take them seriously can be invaluable to de-escalate their situation and reduce their feelings of anxiety. “A lot of times, when chatting with young people, it’s clear that they just need someone to listen to them,” one counsellor said. “Sometimes it’s obvious. They’ll say, ‘Thanks for listening. Nobody ever does that,’ and at other times it’s less explicit; they just want to get everything out, and they provide you with a very, very detailed account.”

Each day, on average, Crisis Text Line instigates at least 25 active rescues of someone who’s believed to be in immediate risk of suicide or homicide. During active rescues, the counsellor continues to engage the texter while the supervisor monitors the conversation and contacts the police.

The organisation collects anonymous data, to improve their service and study overall trends. This has already produced a unique collection of mental-health data. Such a wealth of data is new in the field and could prove extremely useful for public health professionals trying to understand the big picture of mental health issues and suicide in the US, and ultimately improve how the healthcare system is able to respond.

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